Failure to Diagnose & Delay in Treatment of Lupus Erythematosus

Evaluate breaches in the standard of care when analyzing a Failure to Diagnose & Delay in Treatment of Lupus Erythematosus

Answer the following questions to find out if the standard of care was followed for your case.

With which of the following symptoms did the patient present? (Choose all that apply)Joint pain and swellingFacial rashPhotosensitivityOral ulcerPleuritic or pericardial chest painRenal disorder- proteins in urineNeurological symptoms- seizuresNone elicitedAnswer unknownWhy is this important?Systemic lupus erythematosus (SLE) is an autoimmune disorder of unknown etiology that affects numerous organ systems including the renal, cardiovascular, gastrointestinal and central and peripheral nervous systems. There are many atypical presenting patterns that may result in significant delays in diagnosis of systemic lupus erythematosus.(2008) 20 EOMSCA 4 651-662

Which of the following risk factors were elicited from the patient? (Choose all that apply) Why is this important?Answer this questionRisk factors are useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.Click here for additional information at ClinicalKey.com

Was a physical examination performed? Why is this important?Answer this questionA complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.Click here for additional information at ClinicalKey.com

Was the presence of co-existing infection detected? Why is this important?Answer this questionPatients with systemic lupus erythematosus are more susceptible to infection. Coexisting infection with systemic lupus erythematosus must not be missed by the primary care physicians. If the temperature is greater than 102ºF (39ºC), a source of infection should be sought.Click here for additional information at ClinicalKey.com

Was the renal involvement evaluated? Why is this important?Answer this questionRenal involvement must always be evaluated for patients with systemic lupus erythematosus.Click here for additional information at ClinicalKey.com

Which of the following diagnostic laboratory tests were performed? (Choose all that apply) Why is this important?Answer this questionRoutine laboratory studies can provide important clues to diagnosis.Click here for additional information at ClinicalKey.com

Was an anti-nuclear antibody (ANA) test or a fluroscent anti-nuclear antibody (FANA) test performed? Why is this important?Answer this questionThe presence of anti-nuclear antibody is the cardinal feature in systemic lupus erythematosus and occurs in over 90% of cases, depending upon the titer of the anti nuclear antibody. Although anti-nuclear antibody -negative systemic lupus erythematosus can rarely occur, a negative anti-nuclear antibody will call the diagnosis into question. Measurement of anti-nuclear antibody subtypes may also be performed.Click here for additional information at ClinicalKey.com

Did the patient test positive for anti-nuclear antibody / fluorescent anti-nuclear antibody levels? Why is this important?Answer this questionThe anti-nuclear antibody test is highly sensitive for systemic lupus erythematosus. A positive anti-nuclear antibody test result can occur in many other disease states as well as in a large number of healthy individuals. A negative fluorescent anti-nuclear antibody test result essentially rules out systemic lupus erythematosus.(2008) 20 EOMSCA 4 651-662

Did the clinician perform an anti ds-deoxyribo nucleic acid test on the patient? Why is this important?Answer this questionIn a patient with positive anti-nuclear antibody value, additional tests such as an anti ds-DNA test will confirm the diagnosis of lupus erythematosus.(2008) 20 EOMSCA 4 651-662

Was the patient diagnosed with lupus erythematosus? Why is this important?Answer this questionTreatment and therapies vary for different connective tissue disorders.(2008) 20 EOMSCA 4 651-662

Was the patient referred to a specialist? Why is this important?Answer this questionOnce priorities and goals have been agreed on, referral to the appropriate professionals should be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized to enable all patients to achieve their maximum potential.Click here for additional information at ClinicalKey.com

Was treatment initiated for lupus erythematosus? Why is this important?Answer this questionBecause there is no cure for systemic lupus erythematosus and complete remissions are rare, the patient and medical treatment team must devise strategies to control acute flare-ups of the disease and develop medication protocols in which symptoms are maintained at an acceptable level.(2008) 20 EOMSCA 4 651-662

Were the modifiable risk factors for premature atherosclerosis controlled? Why is this important?Answer this questionPatients with systemic lupus erythematosus are likely to suffer from premature atherosclerosis, so primary care physicians should encourage control of modifiable risk factors for atherosclerosis including blood pressure, diet and exercise.Click here for additional information at ClinicalKey.com

Was steroid therapy recommended? Why is this important?Answer this questionCortico-steroids have been the mainstay in the treatment of patients with SLE.(2008) 20 EOMSCA 4 651-662

Was health education provided? Why is this important?Answer this questionExtensive health education must be provided to any patient initiating steroid maintenance therapy.Click here for additional information at ClinicalKey.com

Were periodic follow-up visits recommended? Why is this important?Answer this questionRoutine follow-up evaluations are necessary to offset any complications that may arise. Regular check-ups ensure that changes in health are quickly assessed and remedied.Click here for additional information at ClinicalKey.com

Was corticosteroid therapy stopped abruptly? Why is this important?Answer this questionCorticosteroid therapy should not be stopped suddenly in systemic lupus erythematosus as it leads to complications. The dose must be gradually tapered down.Click here for additional information at ClinicalKey.com